Once again, Paul McHugh has used the ever more tarnished name of Johns Hopkins to distort science and spread transphobic misinformation. This time, it comes via a position statement from the American College of Pediatricians (ACP) a tiny offshoot of a real professional organization, the American Academy of Pediatrics. The ACP is a group of less than 200 ultra-conservative, mostly Catholic, people (most of whom aren't even pediatricians) who oppose letting gay people be parents, the HPV vaccine, marriage equality, birth control and medical care for transgender people. They are in favor of reparative therapy and abstinence-only education, though.
The ACP is designated a hate group by the Southern Poverty Law Center, along with organizations such as the Klan and Aryan Brotherhood.
This would be nothing but an ineffectual fringe organization, if not for McHugh and the fact that the administration at John's Hopkins refuses to disavow him and his positions, despite his legal troubles and close association with numerous hate groups. This position statement is already making the rounds with SPLC designated hate groups, and on widely read right wing news sites accusing parents who affirm their children's identity of "child abuse."
I'm also already hearing from parents of transgender children that relatives and people hostile to them in the community are using this position statement to threaten to report them to child protective services and take their children away.
What makes this worse is that every single talking point in this position statement is a distortion or outright falsehood. Here's the truth about transgender youth, refuting the ACP's position statement point by point.
1. Sex, and chromosomes, are different than gender and gender identity
The ACP tries to dance right past it, but chromosomes do not equal sex, and sex doesn't equal gender. They acknowledge intersex individuals exist, but not what that means. People can have a 46-XY karyotype, and appear and identify as female. They can even have children.
2. Gender identity has biological origins
There are over 150 studies, papers, dissertations and other peer reviewed sources that have found biological origins of gender identity, and gendered behavior, in humans and animals. Most of them found that endocrine disruptions during pregnancy affected both. This concept isn't new: studies from 1973 onward found that pre-natal exogenous estrogen exposure changes in gendered behavior. We also have known for a decade that the male children of women who took diethylstilbestrol (DES) during pregnancy were much more likely to develop gender dysphoria as adults. A recent meta-study by Boston University found, "current data suggests a biological origin of gender identity."
Gender is not a purely social construct or based on upbringing. David Reimer lost his penis in a circumcision accident as an infant, and was raised as a girl. Despite growing up with every social and outward biological factor telling him he was female, Reimer never identified as such, and began living as a male as a teen. Dr. McHugh would know this: this experiment was conducted by Dr. John Money, his predecessor at Johns Hopkins.
Given all this, one can only conclude that Dr. McHugh has deliberately misrepresented the evidence at hand to attack a vulnerable population.
3. Transgender children are not by definition mentally ill
The APA does not consider transgender people to be disordered by definition, and clearly states that in and of itself, being transgender is not an illness. In fact, the APA says the exact opposite: "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition." Dr. McHugh deliberately misrepresents the position of the American Psychiatric Association by asserting that since gender dysphoria is in the DSM, all transgender people are by definition disordered.
Dr. McHugh is a psychiatrist, and such an egregious misrepresentation of his professional organizations' position could not simply be a mistake.
4. Puberty blocking drugs are not new or experimental
The drug used to suppress puberty in transgender children is Luprorelin. It was approved by the FDA in 1985 (a year after ibuprofen became over the counter), and has been approved by the FDA for cisgender children with precocious puberty since 1989. The effects of Lupron are fully reversible, and recent studies of transgender youth receiving Luprorelin have had excellent medical and mental health results.
Lupron has been used on cisgender children for 27 years. The only thing new about it is using it on transgender children for the same biological purpose (delaying puberty). Characterizing Lupron as experimental, irreversible and highly dangerous plays upon the fears of readers and misrepresents the actual data in order to degrade the standard of care for transgender youth.
5. Desistance rates are nowhere near 98%
It is difficult to discern where such an inflated figure came from, because even the most ardent supporters of the desistance narrative used "approximately 80%" as their figure. In reality, this 80% figure is almost certainly highly inflated, since the study it was based on did not actually differentiate between children with consistent, persistent and insistent gender dysphoria, kids who socially transitioned, and kids who just acted more masculine or feminine than their birth sex and culture allowed for. The study could not locate 45.3 percent of the children for follow up, and made the assumption that all of them were desisters. Finally, it used the older DSM-IVTR clinical definitions of Gender Identity Disorder.
As a result, the desistance figure is meaningless, since both the numerator and denominator are unknown. You have no idea how many of the kids ended up transitioning (numerator), no idea how many of them were actually gender dysphoric to begin with (denominator), and no idea how many would count as dysphoric under the old DSM but not the new one (both numerator and denominator). Further research has shown, however, that children who meet the current clinical guidelines for gender dysphoria are as consistent in their gender identity as the general population.
Dr. McHugh has deliberately cherry picked a number from a methodologically flawed study to advocate for parents reject the identities of their children. We know for a fact that children whose families reject their identities are at far greater suicide risk, and McHugh's actions increase that further.
6. Hormone replacement therapy under a doctor's supervision is very safe
A recent study of Hormone Replacement Therapy (HRT) using the largest longitudinal sample ever found none of these risks listed by McHugh, when administered with a modern conjugation of estrogen under a doctor's supervision. Principal Investigator Henk Asscheman, MD, stated,
Our results are very reassuring. There are mostly minor side effects and no new [adverse events] observed in this large population... The take-home message is that when using the guidelines from the Endocrine Society, you are not going to see a lot of comorbidities with cross-sex hormone treatment.
McHugh lists a parade of horrible, life threatening side effects of hormones. However, he neglects to mention these were mostly effects of taking an older conjugation of estrogen that hasn't been used in nearly 15 years, and patients in previous studies were also more likely to have correlated health risks such as smoking. McHugh omitted this key fact.
7. Transgender suicide risk is directly related to stigma and isolation
The overwhelming majority of studies show that discrimination, rejection, and isolation are the cause of high suicide rates in the transgender community. However, McHugh again misuses a 2011 study by Dr. Celia Dhejne to claim the opposite.
Dr. Celia Dhejne has already denounced McHugh's repeated misuse of her 2011 study as "unethical." Yet he does it again claiming that transgender people commit suicide at staggering rates even if they live in tolerant societies. This to imply that transgender people are intrinsically mentally ill unless they somehow are "cured" of the delusion, and that they will still commit suicide even if the stigma of being transgender is lifted.
The problem is, Dhejne's study says the EXACT OPPOSITE of what Dr. McHugh claims. It states that differences in mortality between the general population and transgender people, "did not reach statistical significance for the period 1989-2003." In other words, there was no statistical difference in the suicide rate for transgender people who transitioned after 1989 and the general population.
Put another way, as Swedish society became more tolerant, the difference in suicide rates dropped to non-detectable levels. The data says exactly the opposite of what Dr. McHugh implies, and makes it clear in plain text when Dhejne postulates, "[this] might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions."
Again, McHugh has deliberately and unethically misinterpreted data in order to push religion over good medicine, psychiatry, and social policy at the expense of a vulnerable population on behalf of a hate group.
8. Accepting your child's identity is the healthiest thing you can do for them
The most recent study available showed that transgender youth in supportive homes with access to medical care were not the delusional, suicidal wretches that McHugh implies, but instead had psychological functioning not significantly different from the general population. Another showed that having a family which accepts a child's gender identity reduces the suicide attempt rate by 82%.
Negative outcomes for transgender youth are strongly linked with rejection of their gender identity. One recent study found that children whose parents reject their identities are 13 times more likely to attempt suicide. Over and over again, familial rejection has been linked to suicidal thoughts and behavior.
Instead of following evidence based medicine, McHugh distorts the facts to arrive at a religious based conclusion that parents should reject their child's identity and refuse them affirming mental and medical health care. Every bit of modern evidence we have suggests what he is proposing is dramatically increases the risk of suicide and other psychological comorbidities.
Conclusion
Dr. McHugh's most recent public offering is a disgrace to John's Hopkins name, which he uses so liberally. His position statement is based on distortions, omissions, half-truths, outdated research, and motivated entirely by religious based bias against a group of people already heavily stigmatized by society. The fact that every last one of his points can be disproven by anyone with access to Google discredits the academic standards of the institution.
Somewhere out there, a parent will follow his advice. Or a court, or child protective services. We already know it happens when they do. We know the results from anecdotes and years of research, and it looks like Leelah Alcorn.
This isn't just about academic freedom. It's about the reputation of the institution. It's about the moral obligation to do no harm.
And if all of those things are meaningless to Johns Hopkins administration, it's also about liability. Someday, someone who followed McHugh's advice, with your implied blessing, is going to show up on your doorstep with a lawyer and a dead child.
Your continued silence will not save you from what comes next.
It only damns you further.